Inhaled
corticosteroids (ICS) are important in reducing exacerbation frequency associated with
chronic obstructive pulmonary disease (
COPD). However, little is known about the risk of associated
infections. In a post hoc analysis of the TOwards a Revolution in
COPD Health (TORCH) study, we analysed and identified potential risk factors for adverse event reports of
pneumonia in this randomised, double-blind trial comparing twice-daily inhaled
salmeterol (SAL) 50 microg,
fluticasone propionate (FP) 500 microg, and the combination (SFC) with placebo in 6,184 patients with moderate-to-severe
COPD over 3 yrs. Despite a higher withdrawal rate in the placebo arm, after adjusting for time on treatment, a greater rate of
pneumonia was reported in the FP and SFC treatment arms (84 and 88 per 1,000 treatment-yrs, respectively) compared with SAL and placebo (52 and 52 per 1,000 treatment-yrs, respectively). Risk factors for
pneumonia were age > or =55 yrs, forced expiratory volume in 1 s <50% predicted,
COPD exacerbations in the year prior to the study, worse Medical Research Council dyspnoea scores and body mass index <25 kg.m(-2). No increase in
pneumonia deaths with SFC was observed; this could not be concluded for FP. Despite the benefits of ICS-containing regimens in
COPD management, healthcare providers should remain vigilant regarding the possible development of
pneumonia as a complication in
COPD patients receiving such
therapies.